The Use of Modified Cognitive Therapy to Eliminate or Reduce Depression among Persons with Intellectual Disabilities: A Case Study

Special Article - Disability and Rehabilitation

Phys Med Rehabil Int. 2015; 2(7): 1060.

The Use of Modified Cognitive Therapy to Eliminate or Reduce Depression among Persons with Intellectual Disabilities: A Case Study

Abdoulaye Diallo*, Marcela Villarreal-Lamas, Jennifer Trejo and Noel Ysasi

School of Rehabilitation Services and Counseling, College of Health Affairs, University of Texas - Rio Grande Valley, USA

*Corresponding author: Abdoulaye Diallo, School of Rehabilitation Services and Counseling, College of Health Affairs, University of Texas - Rio Grande Valley, USA

Received: August 22, 2015; Accepted: September 28, 2015; Published: September 30, 2015


There is a high prevalence rate of depression among persons with intellectual disabilities. However, persons with intellectual disabilities can benefit from appropriate cognitive interventions, an effective treatment for depression, despite their cognitive limitations. One such applicable intervention is a modified cognitive intervention that separates false ideas from reality (S), then puts things into perspective (PP), and finally aids the client retain healthy thinking (R) and discard faulty thinking (D) (SPPRD). This case study investigated SPPRD’s outcome in reducing depression in a client with intellectual disability. The SPPRD frame was used to correct the participant’s faulty thinking in a weekly session, about one hour every week for five weeks. Results of the weekly depression evaluations and one time QOL- related evaluation at the fifth week indicate the participant’s level of depression was reduced and his QOL improved after the intervention.

Keywords: Intellectual disabilities; Depression; Modified cognitive interventions

Case Presentation

This case study’s purpose is to investigate the outcome of a modified cognitive approach, based on a novel frame - SPPRD - in reducing or eliminating depression. SPPRD signifies separate false ideas from reality (S), then put things into perspective (PP), and finally aid the client retain healthy thinking (R) and discard faulty thinking (D) (SPPRD). Depression, one of the most common psychiatric illnesses, [1,2], affects about 16 % of the US population at some point in their lives [3]. Experts define depression as an organic or reactive psychological state which is a genuine response to adverse life and frustrating circumstances [4]. Some of the symptoms of depression include difficulties thinking, concentrating, and making decisions, hopelessness and feelings of worthlessness, and decreased energy [5]. The co-occurrence of depression has been linked to suicide; sixty percent of victims were depressed prior to suicide. Because of the above issues, depression remains among the top researched topics [3].

While depression affects all populations, persons with intellectual disabilities (ID) are more prone to this mental illness. According to the Diagnostic and Statistical Manual of Mental Disorder-Fifth Edition- Text Revision [5], ID is a developmental disability that includes intellectual and adaptive functioning limitations in conceptual, practical and social areas. Persons with Intellectual disabilities (ID)’s risk for depression (between 44% and 57%) is higher than that of the general population. They have higher prevalence rates (6-30%) (despite the underreported rate among this population) than women (5-9%), men (2-3%), and persons with disabilities in general (25%) [6]. Persons with IDs face negative circumstances (discrimination, poverty, poor health, past failure) that are related to depression. Also relating to depression is faulty thinking [7,8]. According to CT individuals are depressed because they hold a negative triad with false beliefs about themselves, the world, and the future [9]. In addition to sharing the general susceptibility to negative thinking, persons with ID have had many past failures (because of discrimination and other factors) that reinforce already held and/or causes negative beliefs (e.g., I am an unworthy person or I am a failure); so, persons with ID are additionally vulnerable to depression [1,2].

An individual’s false thoughts may not be limited to deprecating negative beliefs about the self; they may extend to important life’s activities (e.g., employment and education), resulting in and/or compounding depression [2]. For example, if an individual believes his/her failure in an activity means an inability in other activities or failures in other areas or tasks, that is global and stable [10], he/ she may avoid engaging in activities. These universal and stable views of failure by individuals with ID can mean dodging education, employment, and other important life activities, ultimately leading to depression related issues, such as unemployment and poverty. Consequently, persons with ID can become stuck in a cyclical process: depression leads to lack of employment; employment, to depression [6].

Cognitive Therapy (CT) to treat depression due to negative beliefs is, like any other psychotherapy endeavor, a complex activity, subject to limitations, not always used properly, and frequently misapplied to and inappropriate for individuals with limited cognitive abilities [1].

However, clients’ negative thoughts are not incontrovertible and indissoluble despite past failed experiences that appear to support them. In fact, research indicates CT is effective in changing negative thoughts among persons with ID. Nevertheless, research has focused more on cognitive skills limitation rather than on cognitive distortions [11,12]. Research that tackles cognitive issues is paramount given that distorted thoughts are likely to prevail, despite reduction or elimination of cognitive skill limitations [11]. Addressing cognitive related problems among persons with cognitive challenges can be daunting. How then can persons with ID profit from CT interventions (which require cognitive abilities) that focuses on their cognitive limitations?

CT interventions based on concrete and facile models allows persons with ID to benefit from CT [13]. The complex nature of CT’s abstract procedure should drive practitioners to facile and concrete models so persons with ID with limited cognitive abilities can comprehend and digest information provided to them. Studies that have focused on cognition to reduce or eliminate depression among persons with ID, though they exist, are scant, despite consensus among practitioner and researcher regarding CT’s potential in treating depression among the ID population. CT interventions that have been efficacious are those that have concretized the abstract aspects of traditional CT. Such studies include Dagnan& Chadwick (1997), and Lindsay (1999) case studies, and Ross et al. (2000) intervention studies [13-15]. To contribute to knowledge in this area, this case study utilizes a modified CT within the SPPRD model [6]. This is the first modified CT study done using the SPPRD frame.


In the SPPRD model (See Figure 1 above), knowledge about the client or his/her situation (to dispute negative thoughts) is crucial, so story-telling, a narrative therapy strategy, can be used to acquire information about the client, including positive attributes (e.g., affability). These positive characteristics are used to counter and dominate the client’s negative thoughts. Disassociating the client from his/her negative thoughts (e.g., I am unintelligent) is also used to counter them. An appropriate strategy in this regard is McFarlane and Lynggaard’s (2009) narrative strategy of externalization, in which problems are associated with external sources [16]. In SPPRD, the client’s negative beliefs are associated with external sources, such as discrimination and ineffective teaching strategies.

Citation: Diallo A, Villarreal-Lamas M, Trejo J and Ysasi N. The Use of Modified Cognitive Therapy to Eliminate or Reduce Depression among Persons with Intellectual Disabilities: A Case Study. Phys Med Rehabil Int. 2015; 2(7): 1060.